Male involvement in family planning: women's perception.

OBJECTIVES: To assess the knowledge of mothers of under-five children brought to immunisation centres of contraceptive methods applicable by males and their perceptions of the roles of males in family planning. SUBJECTS AND METHODS: This cross-sectional descriptive study involved a questionnaire interview of mothers who came to immunise their children at five public immunisation centres in Port Harcourt. Data entry and analysis employed EPI-Info version 6. RESULTS: Amongst the 558 mothers interviewed, the contraceptive prevalence rate was 5.6% and 85.6% of them knew at least a family planning method for males. About 15.8% would depend on their spouses for choice of contraceptive methods and 52.7% would discontinue family planning if their spouses objected. About 33.5% of the spouses had used some form of contraception while only 22.1% of the females recognised that male involvement could impact on the acceptance rate of family planning services. Despite their knowledge of safe child spacing, about 53% of the respondents delivered within shorter intervals and had significantly more pregnancies/children that they would have had if they were in 'control' of their reproductive health decisions. The spouses, despite being significantly older, more educated, with higher level jobs, and in-charge of the reproductive health decision in the home, did not contribute to the knowledge of the women and their practices of family planning. CONCLUSION: Despite the advantaged position of males in family matters, their roles in family planning remains largely unutilised. If the acceptance of family planning must improve, males should also be targeted by family planning programmes.

Acute flaccid paralysis: a misdiagnosis of poliomyelitis.

BACKGROUND: When the goal of eradication of poliomyelitis was set in 1988, the need for active surveillance for acute flaccid paralysis (AFP) became necessary. This has led to the realisation that although the number of polio endemic countries decreased from 125 in 1988 to 6 in 2004, Nigeria is still one of the high transmission areas for the wild virus. The objective of this paper was to review the need for acute flaccid paralysis surveillance by presenting two cases. METHOD: The case records of two children treated at the University of Port Harcourt Teaching Hospital in 2006 with acute onset of flaccid paralysis were retrieved for presentation. RESULT: Two girls aged 6 years and 13 years presented with sudden onset of flaccid paralysis for which the clinical diagnoses included poliomyelitis. Their stool specimens taken within 2 weeks of onset of symptoms showed no poliovirus. They initially deteriorated clinically but recovered with little or no residual paralysis. CONCLUSION: The need to rule out causes other than polio in all acutely paralysed children is hereby highlighted. All polio eradication strategies should continue to be effectively implemented if we must attain the goal of polio eradication.

Trends in diarrhoeal disease in a southern Nigerian coastal city.

BACKGROUND: Among the goals set at the 1990 World Summit was the reduction of diarrhoeal disease incidence by 50% and its mortality by 25% by 2000. However, despite all efforts, diarrhoeal disease remains a significant contributor to under-five morbidity and mortality in developing countries. OBJECTIVE: This study aimed at determining the role of diarrhoeal diseases in paediatric disease burden at a University Teaching Hospital. METHODS: Data on children with diarrhoeal diseases admitted into the Children Emergency Ward (CHEW) or were attended to at the Diarrhoeal Training Unit (DTU) between 1999 and 2005 were analysed retrospectively. RESULTS: There were 9901 admissions of which 1080(10.91%) had diarrhoea. Diarrhoeal diseases accounted for 8.2% to 15% of the total yearly admissions with a statistically significantly increased contribution between 2003 and 2005 (chi(2)=33.58, df=6, p<0.0001). The children consisted of 628(58.1%) males and 452(41.9%) females; all aged 1 to 180 months; mean 21.3 + or - 26.9 months. Of these 539(49.9%) were infants and 988(91.48%), under fives. The degrees of dehydration were mild in 150(13.9%) children, moderate in 854(79.1%) and severe in 76(7%). During the period, 25 (2.5%) diarrhoea-related deaths occurred. In 2005, 745 children with diarrhoea received care in the DTU compared to 184 admitted for diarrhoea in CHEW. CONCLUSION: Diarrhoea continues to contribute significantly to childhood morbidity. Well-known preventive strategies should be employed on a wide scale to reduce its current burden.

HIV infection and persistent diarrhoea: a comparative study of HIV positive and HIV negative children.

Persistent diarrhoea contributes 20% of diarrhoeal disease burden and 30-50% of its 17% contribution to under-five deaths in developing countries. HIV infection increases the incidence and severity of all childhood diseases, including diarrhoea, and persistent/chronic diarrhoea is one of its presenting features. This study sought to determine the role of HIV seropositivity in persistent diarrhoeal disease morbidity in children managed at the University of Port Harcourt Teaching Hospital (UPTH) from January 1997 to March 2003. This was a retrospective study of all paediatric persistent diarrhoeal cases with known HIV serostatus who were managed at UPTH. Data extracted from their case records included the bio data, presentation, management and outcome of the index episode. EPI Info version 6.04 was used for data entry and analysis. Ninety-nine children, comprising 44.4% HIV positive and 55.6% negative; 57.6% males and 42.4% females, were studied out of which 87.9% were aged 0-23 months. HIV seropositivity was significantly associated with increased duration of diarrhoea, (p<0.007 and the presence of severe wasting, tuberculosis, chronic cough, lymphadenopathy and higher mortality. Persistent diarrhoea-related morbidity and mortality were significantly increased by the co-existence of HIV seropositivity. It is therefore needful not to only scale-up control programmes for both conditions but also to improve their management.

Writing a scientific paper: getting to the basics.

Research is an important tool in the discovery of new events and inevitable in the advancement of our understanding of new phenomena. However, the process of carrying out a research will be incomplete and irrelevant if the results are not published. While the process of carrying out a research is a challenging experience for many researchers, an even more daunting exercise is publishing the research findings. Thus, writing scientific paper requires skill and experience. A scientific paper should have a clear purpose, be organized systematically and target a specific audience. It is important that before planning to write out a scientific paper certain questions regarding the message of the paper and its worthiness, the format, target audience for the message and the journal for that audience, are addressed. These issues are crucial and determine how well written a paper is and its acceptability for publication.

Upsurge of Paediatric Tuberculosis in Port Harcourt; Nigeria: Has HIV Infection any Role?

Background : The Niger Delta region in Southern Nigeria is peculiar; not only for its oil and mineral resources; but also; for the adverse socio-environmental factors; which enhance the occurrence of communicable diseases like tuberculosis and Human Immunodeficiency virus (HIV) infection. Because childhood tuberculous infection is a reflection of ongoing transmission in the community and can be reactivated as adult TB; which in turn maintains a chain of transmission; it is important to determine its incidence in this region. Aim : To describe the pattern of paediatric tuberculosis at the University of Port Harcourt Teaching Hospital (UPTH); Port Harcourt; in the Niger Delta and the role; if any; of HIV co-infection in the cases. Methods: A retrospective analysis of children diagnosed to have tuberculosis; using clinical data; tuberculin test and chest radiography; and managed at the UPTH from January 1; 2002 to October 31; 2005 was done. Results : out of 13;367 children aged 0-15 years who received care at UPTH during the period under review; 188 had tuberculosis. The median age of the tuberculosis cases was 2 years. Seventy six percent were under-fives and 53.2 HIV seropositive. Pulmonary tuberculosis (80.6) was the commonest form of the disease. The proportional incidence of tuberculosis and HIV co-infection increased from 0.88 in 2002 to 87.5 in 2005. Conclusion : Tuberculosis and HIV co-infection seems to be an emerging pattern of paediatric tuberculosis infection in Port Harcourt. There is therefore a need to screen all children with tuberculosis for the presence of HIV co-infection

Salt Iodisation in Port Harcourt Metropolis : a Survey of Households and Markets

Background: Consequent on the recognition of the public health importance of Iodine Deficiency Disorders (IDD); especially in developing countries; the goal of iodising at least 90of edible salts by 2000 was set at the 1990 World Summit for Children.Aim: To determine the salt iodisation level in Port Harcourt.Methods: In April 2000; using pre-tested questionnaires and MBI field test kits; traders from 8 markets and residents of 2181 households in Port Harcourt were interviewed and samples of their edible salts tested to determine their iodine content.Results: The major salt brands of the 336 market and 2182 household samples were Union Dicon (70.54and 25.52) and Cassava (11.9and1.92). About 17of salt samples tested from markets compared to 72.55from households; were of unknown brands (p=0.00000). Over 99of samples from markets and households (99.7and 99.13respectively) had 30 ppm of iodine. All 27 traders interviewed were ignorant of salt iodisation programme and IDD; 92.6had seen persons with 'goitre' but were ignorant of its causes and prevention.Conclusion: Salt iodisation at the point of production has proved effective in increasing the consumption of iodised salts in Port Harcourt despite the widespread ignorance of the programme and its importance in controlling IDD. That most of the salts had 30 ppm of iodine portends the danger of toxicity with long-term use. There is need for close monitoring to ensure the safety of the intervention and its sustainability

Research proposal writing: breaking the myth.

BACKGROUND: Research is an essential activity required for the advancement of science and improvement of human existence. To carry out a research, a proposal is mandatory. However, in spite of the widespread demand for research proposals, experience has shown that a number of them are so poorly written that they rejected by assessors. This article aims at assisting researchers develop acceptable research proposals by reviewing the different components of a research proposal. METHOD: A review of relevant literature on research proposal writing sourced from manual library and internet search was used for this review RESULT: A research proposal is a formal and detailed statement of intent to carry out a research. It presents and justifies a plan of action and shows how the investigator thinks. A research protocol on the other hand is a plan written to seek approval for research from a supervisor or an organization. It is developed as a guide for a study and helps to keep the researcher focused on the topic and scope of the research. A research proposal has the following components: The Title page; The Abstract/Executive Summary; The Introduction/Statement of the Problem; Literature Review; Information on the applicant's centre; The Objectives/Research Questions/Hypotheses; The Study Design; Methods; Plans for Analysis; Data Analysis; Plans for Data Interpretation; Plans to report. Thus, although proposals and protocols are sometimes used interchangeably, a proposal precedes a protocol. CONCLUSION: To reduce the time wastage and frustration faced by intending researchers and their assessors it is essential that good proposals be written at all times.

Upsurge of paediatric tuberculosis in Port Harcourt; Nigeria: Has HIV infection any role?

Background: The Niger Delta region in Southern Nigeria is peculiar; not only for its oil and mineral resources; but also; for the adverse socio-environmental factors; which enhance the occurrence of communicable diseases like tuberculosis and Human Immunodeficiency virus (HIV) infection. Because childhood tuberculous infection is a reflection of ongoing transmission in the community and can be reactivated as adult TB; which in turn maintains a chain of transmission; it is important to determine its incidence in this region. Aims: To describe the pattern of paediatric tuberculosis at the University of Port Harcourt Teaching Hospital (UPTH); Port Harcourt; in the Niger Delta and the role; if any; of HIV co-infection in the cases. Methods: A retrospective analysis of children diagnosed to have tuberculosis; using clinical data; tuberculin test and chest radiography; and managed at the UPTH from January 1; 2002 to October 31; 2005 was done. Results: Out of 13;367 children aged 0-15 years who received care at UPTH during the period under review; 188 had tuberculosis. The median age of the tuberculosis cases was 2 years. Seventy six percent were under-fives and 53.2HIV seropositive. Pulmonary tuberculosis (80.6) was the commonest form of the disease. The proportional incidence of tuberculosis and HIV co-infection increased from 0.88in 2002 to 87.5in 2005. Conclusions: Tuberculosis and HIV co-infection seems to be an emerging pattern of paediatric tuberculosis infection in Port Harcourt. There is therefore a need to screen all children with tuberculosis for the presence of HIV co-infection

A seven-year audit of a diarrhoea training unit (DTU) in Port Harcourt, Nigeria.

The Diarrhoea Training Unit [DTU] of the University of Port Harcourt Teaching Hospital in Nigeria was established in 1991 and has, in addition to treating cases, been involved in training medical students, paediatric residents, health workers and mothers caregivers on correct case management of diarrhoeal disease. The accomplishment of the Unit over a defined time frame, January 1993 to December 1999, was evaluated by employing predetermined indicators and the data were analyzed by using the Statistical Package PEPI [Computer Programs for Epidemiologic Analysis Version 2.07a]. Eight thousand, four hundred and eighty-six cases (4557 males and 3929 females) of acute diarrhoea were treated. Those with severe dehydration were eleven times fewer in 1998 and eight times fewer in 1999 than in 1993. The number of Oral Rehydration Salts (ORS) sachets used in the Unit increased from 3064 in 1993/94 to 17,549 in 1998/99. There was no reduction in the number of cases treated, but the case-fatality rates dropped from 6 per 1000 in 1993 to 0.6 per 1000 in 1999 [likelihood ratio chi2 = 9.874, p = 0.02]. There was a significant reduction in the proportion of patients with bloody stools towards the end of the observation period [chi2(trend) = 82.60, 1 df, p = 0.000 (1.00E-19)]. These results indicate some positive impact on the severity of diarrhoea in the area, but preventive measures should now constitute the main thrust.

Social-environmental influences on the occurrence of neonatal tetanus in some riverine communities in Nigeria.

PIP: The factors associated with neonatal tetanus occurrence were rank ordered in a survey of 1867 children from a community in Nigeria with a previously documented high prevalence of this infection. The study, restricted to children born in 1992, 1993, and 1994, was conducted in the first 2 weeks of 1995. There were 28 cases of neonatal tetanus, for a rate of 15/1000 live births. Although cases and controls lived under similar social and environmental circumstances, three factors emerged as significant risk factors for neonatal tetanus: 1) lack of maternal education to the secondary level, 2) lack of antenatal care, and 3) delivery in a nonmedical establishment. Moreover, these three factors were linked. Mothers educated beyond the primary school level were more likely to understand the importance of antenatal care and to receive tetanus toxoid vaccination; if they received antenatal care, they were more likely to deliver in a medical establishment. Thus, eradication of illiteracy among women in Nigeria represents a priority in the effort to prevent neonatal tetanus.^ieng

Anthropometric indices in singleton term neonates and their possible value in predicting some metabolic problems: a preliminary study.

We studied possible sources of variations in selected anthropometric indices and their relationship to neonatal metabolic problems in seventy-four singleton neonates born at an approximate gestation of 40 weeks, by selected anthropometry. There were significant differences particularly in values obtained for birth weight, mid upper arm circumference, chest circumference and the Ponderal Index. At the moment it is not possible to set discriminant values on any of the anthropometric indices as this will require a much larger sample size, however the authors believe that the use of anthropometry in predicting metabolic problems in neonates has some potential and serial measurements of particularly chest circumference, mid upper arm circumference and the Ponderal Index could form the basis of future studies.

A prospective clinical study of patients with hypernatraemic dehydration.

In a clinical prospective 3-year study of 158 children aged 2 weeks to 14 years with hypernatraemic dehydration (serum sodium 150 mmol/l or more), infants predominated (61.4%). The 158 children with hypernatraemia accounted for 13.7% of all children admitted with gastroenteritis over the same period, and significant aetiological factors included the use of artificial feeds, differences between the children with hypernatraemia and those with normo- or hyponatraemia, P < 0.001, P < 0.001, respectively; the use of breast milk, P < 0.001, P < 0.001, respectively; nutritional status, P < 0.001, P < 0.001, respectively; and clinical state of mild to moderate dehydration P < 0.001; P < 0.001, respectively; but not with patients considered severely dehydrated. There was also a significant difference between the presence of neurological features in hyper- and normonatraemic patients P < 0.001; in hyper- and hyponatraemic patients P < 0.05, and in mortality rate between hyper- and normonatraemic patients, P < 0.05 but not between hyper- and hyponatraemic patients. A history of refusal to feed or vomiting was obtained in 41 children (25.9%). The mean serum sodium was 155.5 mmol/l (range 150-189 mmol/l); mean serum urea 7.7 mmol/l (range 1-18.9 mmol/l). Hypernatraemic dehydration remains an important and serious complication of childhood gastroenteritis in our area of study. The use of artificial milk feeds is contributory, and well-nourished babies appear more at risk. We recommend more liberal water intake during gastroenteritis and the public should also be educated on and made more aware of this condition.

Jigger infestation in children in a rural area of Rivers State of Nigeria.

During a survey in April 1991 to determine the immunisation status of 218 children resident in a rural riverine community, 49 (22.48) were found to have been infested with Tunga penetrans. Itching and ulceration were the commonest symptoms. The feet were infested in all children, none of whom was taken to a health facility. 42.86% of infested children received complete doses of DPT. Parents reported no complications of infestation. Tungiasis is an important infestation in rural dwellers. The need for adequate childhood immunisation and use of protective clothing and shoes are highlighted.